What is anterior knee pain? What kind of pain is it?
“It is a very common pain. It is seen in nearly thirty percent of patients applying to orthopedic clinics. For this reason, it is one of the important problems that concern society. Anterior knee pain is pain felt in the front part of the knee, especially when descending, ascending and squatting stairs. While these symptoms are seen at the beginning, as the disease progresses, people's complaints also change. Patients generally experience difficulty in movements that involve bending the knees, such as squatting. Hearing crunching or rubbing sounds in the knees is also common
“Anterior knee pain is a more common disease in flat feet. The system from our hip to the tip of our toes is mechanically interconnected. There is a connection with anterior knee pain not only in people with flat feet, but also in patients with lower back problems, knee deformities, and protrusion of the big toe. Because once the mechanics breaks down, it can have upward or downward effects in a chain manner. Therefore, anterior knee pain is more common in people with flat feet.”
This is taken from the patient's history, the patient's examination, and imaging methods such as MRI, film, and x-ray. Listening to the patient is one of the most important parts. Sometimes a patient comes and says, 'I don't have much of a problem walking on a normal, level road. Even if I walk long distances, there is no problem. If someone says 'But I have pain when going down the stairs', we immediately think of pain in the front of the knee. Since more load is placed on the kneecap bone when descending the stairs, we stimulate the patient with front knee pain more with this movement. Likewise, the patient squats down, e.g. "If we feel pain in the kneecap while praying, we think of pain in the front of the knee and problems with the kneecap." Anterior knee pain should not be neglected. Because one of the most important causes of anterior knee pain is the imbalance of muscle groups; While there is weakness in the anterior group of muscles, tension is observed in the posterior group of muscles. When we allow this to happen, permanent damage occurs to the cartilage behind the kneecap. It is not possible to correct this situation. The ideal thing is to go to the doctor and solve the problem early. The place of the price is very limited
There are a few situations that the patient should pay attention to here. Pressure should not be applied to the area that has not fully healed without the doctor's permission. If the doctor recommends using a cane for six weeks, this should be followed. Some medication support may also be given. In nutrition, calcium-rich foods should be consumed
Meniscus and Knee Diseases
The menisci, which almost all of us know as a word but I think we do not know their exact importance, are C-shaped inside the knee joint, one of which is They are cushions made up of two cartilages, one inner and one outer. Thanks to them, it is possible for the two bones that make up the knee joint to move in harmony with each other without harming each other.
MENUS PROBLEMS
The most common complaints about the knee are problems with the meniscus. Tears may occur in the meniscus during sudden sprains and/or rotations of the knee. Symptoms of meniscus tear are; It may present as pain in the knee, tripping, pain when descending stairs, pain when squatting and sometimes locking.
The diagnosis of meniscus tear is made by examination of the orthopedic doctor and subsequent Magnetic Resonance Imaging (MRI). While open surgical interventions were previously performed in the treatment of meniscus tears, today a modern treatment method, arthroscopy, is used. During arthroscopy, the patient is first given anesthesia (general, spinal/epidural or local). The knee joint is entered through a tube connected to the optical system (camera) with a diameter of approximately 5 mm. The image of the inside of the knee is reflected on the screen. In this way, the meniscus, ligaments and other structures within the knee are examined. Then, a second hole with a diameter of 5 mm is opened and the torn meniscus is intervened by seeing it on the screen, using special tools inserted through this hole. To give a rough analogy, one of the entry holes is the surgeon's hand and the other is the surgeon's eye.
In most meniscus tears, removing the torn part is sufficient for treatment. In cases where the outer part of the meniscus has healing potential, it is repaired arthroscopically by suturing the meniscus and waiting for healing. This is a more ideal situation, and if the tear type, location and freshness allow this, the chance of repair should definitely be tried.
Menisci. It can tear in different ways depending on both age and the mechanism of the injury; Longitudinal, transverse and parallel tears are among the tears we generally encounter. A structurally sound meniscus may be torn when the knee moves in a direction different from the normal direction of movement as a result of an accident or impact. A meniscus that is structurally unstable, such as one whose structure has been damaged due to old age or repeated minor wear, can tear much more easily. In the elderly, these tears become frayed and deteriorate over time.
Young patients are more likely to present with sports injuries. Particularly, the fact that artificial turf fields are widespread in our country and that most of them are not built under suitable conditions, coupled with unconsciousness and starting the match without warming up enough, causes many injuries, including meniscus tears. In the elderly, in addition to negative changes in the meniscus tissue over time, tears due to excess weight and calcification in the knee are observed.
Although there are no definitive distinguishing findings, the following symptoms should bring to mind a meniscus tear; Pain when kneeling, standing for long periods of time, or climbing stairs. If the tear is released at one end or completely, mechanical symptoms, that is, jamming and locking in the knee, may also be observed.
Even if an MRI is performed on someone who has no pain, a meniscus tear may occur. In other words, if an arthroscopy is performed without examination because a tear is seen in the MRI of a patient whose knee hurts, and if the pain comes from another source, the patient will not benefit from the surgery. For this reason, a detailed examination should be made and the most correct decision should be made.
Meniscus ensures the harmony of the bones with each other. If the meniscus had to be removed, the harmony of the bones is disrupted, and the phenomenon we call calcification occurs at an earlier age than in people with a healthy meniscus. In order to delay this, the load on the knee should be kept low, that is, not to gain weight and not to lift too heavy. Exercise should become a lifestyle.
KNEE CAP (PATELLA) PROBLEMS
One of the most common problems in the knee joint is the problems with the knee bone cartilage called patella. Pain in the front of the knee, pain when ascending or descending stairs, desire to straighten the leg after long sitting. It causes complaints such as: This load is greater in people who are overweight, and if there is structural sensitivity in the cartilage of the lid bone, the cartilage begins to wear away. This wear manifests itself with pain. Special exercises play a very important role in eliminating the problem. Special knee pads produced for this purpose are useful in the treatment. In advanced cases, if there is a significant structural disorder, a number of special surgeries can be performed to reduce the pressure on the kneecap bone.
Anterior Cruciate Ligament Ruptures
One of the knee injuries seen especially in athletes is anterior cruciate ligament ruptures. The complaint begins with a severe rotation in the knee and swelling behind it, and then causes symptoms such as insecurity in the knee and knee discharge while walking or running. Examining the patient and evaluating the laxity of the knee is the most important diagnostic tool in the evaluation of the anterior cruciate ligament. Anterior cruciate ligament tear is precisely determined by MRI examination. In the treatment of anterior cruciate ligament rupture, anterior cruciate ligament surgery is unquestionably performed if the patient is young, an active individual, an athlete, or if there is strain on the knee during daily work. In anterior cruciate ligament surgeries, tendons taken from the front (patellar tendon) or inner side (hamstring tendons) of the knee are replaced arthroscopically with special fixation systems instead of the torn anterior cruciate.
CALCIFICATION OF THE KNEE JOINT (GONARTROSIS)
It occurs when the cartilages that make up the knee joint deteriorate and the joint becomes deformed. It is especially seen in overweight people in middle age and later. The knee joint is painful. It is swollen and deformed. It is painful for the patient to walk and go up and down stairs. Over time, pain occurs even when lying down at night. After the condition of the knee is evaluated by examination and x-ray, special knee exercises, weight loss and medication are first applied in the treatment of knee arthritis. Cartilage strengthening drugs administered into the joint and special knee braces are used in the treatment. Physical therapy may be applied at certain periods. Arthroscopic intervention in appropriate cases with meniscus tear, especially in the presence of mechanical findings and It may be partially beneficial if there is no significant axis disorder. Total knee replacement surgery is performed in advanced knee arthritis. With this surgery, the damaged joint surfaces are removed and replaced with a special prosthesis made of metal and polyethylene materials. In this way, the aim is for the patient to walk without pain.
ARTHROSCOPY
Arthroscopy is used in the treatment of meniscus tears, cleaning of early joint calcifications (in special cases and with mechanical symptoms), removal of free bone and cartilage pieces within the joint. It can be applied in removal, anterior and posterior cruciate ligament injuries, infection or edema in the knee, kneecap bone problems, treatment of articular cartilage damage and treatment of intra-articular fractures.
Recovery is rapid after the treatment of a simple meniscus tear with the arthroscopic method. Many patients can stand up, walk with weight on the arthroscopy leg, and function at home on the same day without the need for crutches. After the first week, he can take short walks outside the home, and after the third week, he can return to his normal daily life.
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